Urinary Tract Infection in the

Elderly

Risk factors in Elderly

medications:
AH, AntiCh, Anti psychotic, analgetics decreased
parasympathetic tone urinary flow decrease, fecal
impaction urinary retention, post void volume incr
bacterial colonisation

Behavioral : incontinence poor hygiene

Physiological : voiding dysfunction (incontinence,
increased residual volume, poor hygiene)

UTI in...
Walking well

Elderly

With chronic
disease
Institutionalized

UTI in the Walking Well Elderly

UTI

Sign and Symptoms

Urethritis

Dysuria, purulent discharge

Bacterial Prostatitis

Dysuria, frequency,
Suprapubic, pelvic, perineal pain
Fever, malaise

Reccurence rate >50% in

elderly (acute)
Chronic (symptoms > 3mos)

Cystitis

Dysuria, urgency, frequency,,

F>M
F : Poor hygiene
M :Urinary retention (BPH,
bladder enervation)
FR:
DM, Dementia, pelvic
relaxation syndrome

Interstitial Cystitis
(painful bladder
syndrome)

Pelvic pain, urgency, frequency,

without bacteriuria

e/: hormonal ,
radiotherapyaltering
mucosal lining

Honeymoon cystitis

ysuria, urgency, frequency,,

Folllowing sexua, intercpourse

UTIs Secondary to Chronic Disease

Due to
Diabetes Mellitus

Elderly with DM : 5x increased UTI risk

Asymptomatic bacteriuria + DM needs
special assessment ( risk on UTI in
18months)
Patophysiology
Glycosuria increased adherence
of bacteria
Decreased neutrophils function

Pyelonephritis

Ascending from lower UTI

Renal calculi

Stone obstruction stasis infection

struvite stone
Hyperuricemia, hypercalcemia

Fever, nausea, vomiting,

abdominal pain, Flank
pain,

UTI in Institutionalized Elderly

Difficult to assess
symptoms
12-30%

less able to excrete acid

and urea fail to
maintain normal
osmolality.

Often complicated by
underlying or chronic
disease

increased perineal
colonization, vaginitis, and
bacterial colonization in
the bladder.
BPH tendency

Additional risk factor:

Decreased cognition + incontinence
bedwetting or soiling, skin breakdown, secondary
infection placement of a permanent urinary catheter
risk of urosepsis (bacteremia with systemic infection
and potential vascular collapse).

Urinary catheterization
medications

Asymptomatic Bacteriuria
50% institutionalized
elderly
almost 100% in
catheterized pt.
Some resolve
spontaneously, some
become symptomatic

>100,000 CFU/ml
without symptoms or
signs

Benign, transient,
and does not require
AB.

Therapy is proven
ineffective in
reducing morbidity
and mortality rate.

Screen before
genitourinary
procedure,

If + Levofloxacin
500mg SD PO

DIAGNOSING UTI in ELDERLY

UTI criteria for elderly still lacks of agreement

Diagnosis
history

Burning sensation when voiding, frequency, urgency, bed wetting, fall, fatigue
Difficult to assess due to symptoms overlap, decreased cognitive

Appears ill and distressed

Fever or hypothermia might be slight/non
Suprapubic, CVA tenderness, Urethral discharge
Physical
Examination Gynecologic exam :Organ prolapse, BPH

lab

UA: proteinuria, RBC, WBC > 10/HRF, nitrit

CBC : leukocytosis
Culture if no progress after 2 days pharmacotherapy

Culture results

therapy
Walking well patients:
1st line: Sulfonamid or ampicilin (3d)
2nd line : kuinolon

Prostitis
Acute : kuinolon, sulfa (4-6wk)
Chronic : culutre and sensitivity test AB 12wk

Asymptomatic bacteriuria/funguria no th/

Conclusion
Various geriatric populations are affected by UTIs.
Each of these populations is impacted in different
ways and requires a different treatment
approach.
Symptoms of UTI in elderly patients may differ
from general population
The treatment must be based on the patient's
overall health, underlying chronic conditions, and
ability to care for himself or herself.

Thankyou